ABSTRACT

Background

Graduate medical education (GME) program leaders struggle to incorporate quality measures in the ambulatory care setting, leading to knowledge gaps on how to provide feedback to residents and programs. While nationally collected quality of care data are available, their reliability for individual resident learning and for GME program improvement is understudied.

Objective

To examine the reliability of the Healthcare Effectiveness Data and Information Set (HEDIS) clinical performance measures in family medicine and internal medicine GME programs and to determine whether HEDIS measures can inform residents and their programs with their quality of care.

Methods

From 2014 to 2017, we collected HEDIS measures from 566 residents in 8 family medicine and internal medicine programs under one sponsoring institution. Intraclass correlation was performed to establish patient sample sizes required for 0.70 and 0.80 reliability levels at the resident and program levels. Differences between the patient sample sizes required for reliable measurement and the actual patients cared for by residents were calculated.

Results

The highest reliability levels for residents (0.88) and programs (0.98) were found for the most frequently available HEDIS measure, colorectal cancer screening. At the GME program level, 87.5% of HEDIS measures had sufficient sample sizes for reliable measurement at alpha 0.7 and 75.0% at alpha 0.8. Most resident level measurements were found to be less reliable.

Conclusions

GME programs may reliably evaluate HEDIS performance pooled at the program level, but less so at the resident level due to patient volume.

ABSTRACT

Background

Residency selection integrates objective and subjective data sources. Interviews help assess characteristics like insight and communication but have the potential for bias. Structured multiple mini-interviews may mitigate some elements of bias; however, a halo effect is described in assessments of medical trainees, and degree of familiarity with applicants may remain a source of bias in interviews.

Objective

To investigate the extent of interviewer bias that results from pre-interview knowledge of the applicant by comparing file review and interview scores for known versus unknown applicants.

Methods

File review and interview scores of applicants to the University of Ottawa General Surgery Residency Training Program from 2019 to 2021 were gathered retrospectively. Applicants were categorized as “home” if from the institution, “known” if they completed an elective at the institution, or “unknown.” The Kruskal-Wallis H test was used to compare median interview scores between groups and Spearman's rank-order correlation (r_s) to determine the correlation between file review and interview scores.

Results

Over a 3-year period, 169 applicants were interviewed; 62% were unknown, 31% were known, and 6% were home applicants. There was a statistically significant difference (P=.01) between the median interview scores of home, known, and unknown applicants. Comparison of groups demonstrated higher positive correlations between file review and interview scores (r_s=0.15 vs 0.36 vs 0.55 in unknown, known, and home applicants) with increasing applicant familiarity.

Conclusions

There is an increased positive correlation between file review and interview scores with applicant familiarity. The interview process may carry inherent bias insufficiently mitigated by the current structure.

ABSTRACT

Background

The challenge of graduate medical education is to prepare physicians for unsupervised practice while ensuring patient safety. Current approaches may inadequately prepare physicians due to limited opportunities for autonomy. Recent work on how trainees gain autonomy shows that they actively influence their supervisors' entrustment decisions. If program directors more clearly understand how trainees experience increasing independence, they may better sensitize trainees to the deliberations they will face during patient care.

Objective

The authors sought to explore how trainees experience lessening supervision as their clinical training advances.

Methods

Using constructivist grounded theory, the authors recruited trainees from various specialties and training levels via email and conducted 17 semi-structured interviews from 2019 to 2020 to solicit clinical experiences during which their perceived autonomy changed. Through constant comparison and iterative analysis, key themes and conceptual relationships were identified.

Results

Seventeen trainees from 4 specialties described novel clinical situations that required “overextending,” or going beyond their perceived edge of evolving expertise. This move represented a spectrum based on perceived locus of control, from deliberate overextending driven by trainees, to forced overextending driven by external factors. Trainee judgments about whether or not to overextend were distilled into key questions: (1) Can I do it? (2) Must I do it? (3) Do I want to do it? and (4) Is it safe to do it? More advanced trainees posed a fifth question: (5) Am I missing something?

Conclusions

Decisions to move into the realm of uncertainty about capabilities carried weight for trainees. In making deliberative judgments about overextending, they attempted to balance training needs, capability, urgency, and patient safety.

Introduction

The Annual Educational Conference (AEC) is the Accreditation Council for Graduate Medical Education's (ACGME's) largest learning and networking event targeted toward the graduate medical education (GME) community. In recent years, the ACGME's Council of Review Committee Residents (CRCR)—a council composed of resident and fellow representatives from all accredited specialties—contributed conference presentations and attended the meeting. Consistently, CRCR members described the personal value they found in attending sessions, networking, and the overall experience. Many members expressed an interest in recruiting other trainees interested in future roles in GME to similarly attend.

During the 2019 AEC, there was substantial growth in

The 2022 ACGME Annual Educational Conference, Meaning in Medicine: Rebuilding Connections, brought together over 5000 members of the graduate medical education (GME) community, giving peers and colleagues the opportunity to reconnect while also discussing academic medicine's latest topics and most important initiatives. Participants heard from more than 200 speakers who provided a learning space that encouraged engagement, perspective, and dialogue during the virtual conference that was held March 30-April 1, 2022 (Box).